Novel utilization of imaging can be an important asset to primary care physicians "objectifying" clinical findings. Readily accessible consultation to primary care physicians can significantly improve the process of care in "difficult cases". When a health plan is process engineered according to an individual patient's needs, an effective system, individually tailored medicine (ITM), can be developed. The ITM system has a focused set of goals defined by a formal process model and driven by objective assessments for what is best for the patient. This kind of systematic process model considers the patient as the most important entity in the health care plan. All electronic infrastructure support including all requirements for telemedicine must be integrated into this systematic process model of care. The electronic infrastructure proposed has evolved from the proposers' past experience in the development of picture archiving and communication systems (PACS), intelligent information retrieval systems, and their daily clinical experience with a transcontinental teleradiology service. This system will feature a novel medical information processing architecture that will support fast, reliable, intelligent access to distributed patient records. The performance of the system is enhanced compared to a generic computer network by using predictive models for user behavior and data access patterns. Software modules that support cooperation and collaboration among teams of health care workers will be developed. An intelligent directory will provide patient and physicians with an up-to-date view of availability of services offered by specialists around the country. Electronic case managers will be responsible for notifying the specialist chosen, providing real time monitoring of patient status, compiling necessary patient records distributed among heterogeneous sources and communicating and coordinating results back to the referring physician. The proposers will evaluate technical feasibility of such a system. The technical feasibility although necessary, is not a sufficient condition for demonstrating clinical effectiveness. The goal of the clinical evaluation study is to provide scientifically valid data for quality of care, benefit to the patients, benefit to providers and cost-effectiveness associated with the proposed system when compared to traditional care.